Some surgeries postponed at Royal Alex; more to come, AMA warns

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Some elective orthopedic surgeries at an Edmonton hospital have had to be postponed or diverted this week.

Alberta Health Services confirmed the University of Alberta School of Medicine consolidated the on-call component of its orthopedic residency training program at the University of Alberta Hospital, and some surgeries scheduled to be completed at the Royal Alexandra Hospital have been postponed.

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AHS CEO Athana Mentzelopoulos said in a statement Wednesday that officials are working hard to find alternative coverage and that the health authority neither informs nor directs these decisions.

“Urgent and emergency surgeries will continue at the site,” Mentzelopoulos said.

“We acknowledge that this is extremely frustrating to those impacted patients, and we apologize for any disruption these postponements will cause. We are working hard to get those impacted patients rescheduled as quickly as possible.”

Impacted surgeries include elective arthroplasty hip, knee, and shoulder cases, and elective spine cases, which are normally undertaken at the Orthopedic Surgery Centre and the Diagnostic Treatment Centre.

In the Edmonton Zone, arthroplasty hip and knee surgeries are continuing as usual at the Misericordia Community Hospital. Arthroplasty shoulder surgeries will continue at the Sturgeon Community Hospital and the University of Alberta Hospital as usual.

Additional orthopedic surgery capacity is being explored elsewhere, Mentzelopoulos said.

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“All efforts will be made to ensure minimal loss of the number of surgeries performed, although the type of surgeries done will vary,” she said.

According to the U of A surgical residency site online, the Royal Alexandra Hospital (RAH) operates one of Canada’s busiest emergency departments, with more than 78,000 visits per year.

RAH operates 678 beds, and cares for over 1/2 million patients annually, with over 4,800 full and part-time staff.

There are 31 operating theatres doing 37,000 surgeries annually, and RAH is Canada’s leader in robotic surgeries.

There are 3,700 hip and knee replacements done annually in Edmonton between the Orthopedic Surgery Centre across from the Royal Alex, Misericordia Hospital, and the RAH.

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Outdated funding model: AMA

The loss of orthopedic residents may be just part of a more systemic problem affecting not just the RAH, according to Dr. Paul Parks, president of the Alberta Medical Association.

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An outdated pay system for hospitalists, doctors who specialize in hospital care, is contributing to a vacuum effect, sweeping doctors away from those roles to family practice and other specialties.

That is adversely affecting the RAH and hospitals elsewhere in the North Zone, Parks said.

Hospitalists are paid on a salary-based “alternative relationship plan,” different from the current fee-for-service model through which family doctors are paid.

“It’s not only too low compared to other provinces, it’s also too low compared to just our fee for service within Alberta. It hasn’t been updated in 15 to 20 years.

“We have a massive issue across the province with funding that ARP,” Parks said.

“In Grande Prairie right now, because we can’t move on this alternative funding plan for our hospitals. they are having a hard time actually admitting any type of sick patients to their hospital. And we’re right on the brink of losing all our hospitalists in Calgary,” he said.

“I do think that this orthopedic surgery at the Alex is just the first of many dominoes.”

The AMA presented the hospitalist gap to the province seven months ago, one of three pillars to be addressed, along with stabilization of family medicine and acute care.

“AHS was in full agreement with us that these were top priorities, and these had to be adjusted,” Parks said.

“’Refocusing’ has been a massive distraction for government. And though I do think the government may not have liked it, they inherited this problem. This has been growing for 15 years, but I don’t think that they share urgency because of the way they budgeted,” he said.

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